The present invention relates to surgical tools and method and, more particularly, to a set of surgical tools and a surgical method for anterior cruciate ligament reconstruction.
In certain instances following a knee injury, the anterior cruciate ligament which connects the femur and the tibia breaks and needs reconstruction.
The prior art teaches two main alternatives for anterior cruciate ligament reconstruction.
According to the first alternative, the medial part of the patella tendon, which connects the patella and the tibia, is used to reconstruct the anterior cruciate ligament. To this end, the medial part of the patella tendon is surgically removed along with bone portions of the patella and the tibia, which remain connected to the ends of the removed tendon portion. A first drill having an entrance opening and an exit opening is formed in the knee portion of the tibia and a co-aligned second drill having an entrance opening and a rear wall is formed in the femur, wherein the axis of the co-aligned drills is located substantially along the original path of the anterior cruciate ligament. The patella derived bone portion is inserted into the drill formed in the femur, whereas the tibia derived bone portion is inserted into the drill formed in the tibia, such that the medial part of the patella tendon is located substantially along the original path of the anterior cruciate ligament. Both bone portions are then fixated in place using interference screws.
The advantage of this procedure is that it allows immediate post operation full weight bearing. Its disadvantages include complications associated with the fact that portions of the patella and the patella tendon are removed, leading in some cases to fractures in the patella and/or tearing of the remaining portions of the patella tendon.
According to the second alternative, the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon, which connects the tibia with the thigh muscle, are used to reconstruct the anterior cruciate ligament. To this end, the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon are surgically removed. A first drill having an entrance opening and an exit opening is formed in the knee portion of the tibia and a co-aligned drill also having an entrance opening and an exit opening is formed in the femur, wherein the axis of the co-aligned drills is located substantially along the original path of the anterior cruciate ligament. The semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon are folded to have a folded end and two free ends and are thereafter inserted into the drills formed in the tibia and the femur, such that the folded end of the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon protrudes out of the exit opening of the drill formed in the femur, whereas the free ends of the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon protrude out of the entrance opening of the drill formed in the tibia. Then, a surgical endobutton is attached to the folded end of the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon via a suture, whereas the free ends of the semitendinosus or the semitendinosus and the gracilis of the pes anserinus tendon are attached to the tibial surface using surgical staples.
The advantage of this procedure is the avoidance of the complications associated with the alternative procedure. Its disadvantages include the formation of two, as opposed to one, drills having both entrance and exit openings, which increase the chances for post operation infections and further that full weight bearing can be exercised only about three weeks post operation.
There is thus a widely recognized need for, and it would be highly advantageous to have, a set of surgical tools and a surgical method which enjoy the advantages of the prior art procedures, yet devoid the limitations associated therewith.
According to one aspect of the present invention there is provided a surgical inserter for inserting through a drill formed in a bone and for screwing into a rear wall of the drill formed in the bone a surgical screw having a ring, through which ring a band of connective tissue being inserted, the surgical inserter comprising (a) a head portion being formed with a ring acceptor for accepting the ring of the surgical screw; and (b) a neck portion being connected to, or integrally formed with, the head portion, the neck portion being formed with two longitudinal grooves for engaging the band of connective tissue therein, so as to enable inserting the surgical screw and the band of connective tissue through the drill formed in the bone, and screwing the surgical screw into the rear wall of the drill formed in the bone with minimized damage to the band of connective tissue.
According to another aspect of the present invention there is provided a set of surgical tools comprising (a) a surgical inserter for inserting through a drill formed in a bone and for screwing into a rear wall of the drill formed in the bone a surgical screw having a ring, through which ring a band of connective tissue being inserted, the surgical inserter including (i) a head portion being formed with a ring acceptor for accepting the ring of the surgical screw; and (ii) a neck portion being connected to, or integrally formed with, the head portion, the neck portion being formed with two longitudinal grooves for engaging the band of connective tissue therein, so as to enable inserting the surgical screw and the band of connective tissue through the drill formed in the bone, and screwing the surgical screw into the rear wall of the drill formed in the bone with minimized damage to the band of connective tissue; and (b) a surgical sleeve for covering the inserter and the band of connective tissue while inserting the surgical screw and the band of connective tissue through the drill formed in the bone, and screwing the surgical screw into the rear wall of the drill formed in the bone.
According to yet another aspect of the present invention there is provided a surgical method of anchoring a band of connective tissue to a rear wall of a drill formed in a bone, the method comprising the steps of (a) providing a surgical screw having a ring; (b) inserting the band of connective tissue through the ring; and (c) using a surgical inserter, inserting the screw into the drill and screwing the screw into the rear wall of the drill.
According to still another aspect of the present invention there is provided an anterior cruciate ligament reconstruction surgical procedure comprising the steps of (a) forming a first drill in a tibia, the first drill having a first entrance opening and an exit opening, the exit opening facing a femur; (b) forming a second drill in the femur, the second drill having a second entrance opening and a rear wall of femur bone; (c) providing a surgical screw having a ring; (d) inserting a band of connective tissue through the ring; and (e) using a surgical inserter, inserting the surgical screw through the first drill into the second drill and screwing the screw into the rear wall of the second drill.
According to further features in preferred embodiments of the invention described below, the surgical method or procedure further comprising the step of covering the surgical inserter with a surgical sleeve, thereby protecting the band of connective tissue while inserting the screw into the drill and further while screwing the screw into the rear wall of the drill.
According to still further features in the described preferred embodiments the surgical inserter includes a head portion being formed with a ring acceptor for accepting the ring of the surgical screw and a neck portion being connected to, or integrally formed with, the head portion, the neck portion being formed with two longitudinal grooves for engaging the band of connective tissue therein.
According to still further features in the described preferred embodiments the surgical inserter further includes a handle connected to, or integrally formed with, the neck portion.
According to still further features in the described preferred embodiments the handle is removable.
According to still further features in the described preferred embodiments the ring acceptor is U-shaped.
According to still further features in the described preferred embodiments the ring acceptor includes undercuts formed in the head portion.
According to still further features in the described preferred embodiments the neck is round in cross section, whereas the two longitudinal grooves interfere with the roundness.
According to still further features in the described preferred embodiments the band of connective tissue is a band of an artificial connective tissue.
According to still further features in the described preferred embodiments the band of connective tissue is a band of a ligament, a tendon or a portion thereof.
According to still further features in the described preferred embodiments the band of connective tissue is derived from a pes anserinus tendon.
The present invention successfully addresses the shortcomings of the presently known configurations by providing surgical tools and a surgical method for anterior cruciate ligament reconstruction which enjoys low rates of post operation infections and complications and which allows immediate post operation full weight bearing. Thus, the present invention combines all of the advantages of the prior art procedures of cruciate ligament reconstruction described in the Background section above, while at the same time, avoids the limitations associated therewith.